Sunday, November 25, 2012

Yet do I marvel.

Someone asked me the other day--or rather they made more of a statement to me:"I'm so amazed that you've been able to write with all that's going on."

I wasn't really sure what to make of that, but I'm pretty certain that it wasn't meant to be insulting so I just shrugged. Because I'm kind of amazed, too.

I won't really go into that much more, but instead I'll just say that I'm glad to have a voice. Man, I am.

Speaking of which.

I received a message yesterday from one of the former students in my very first small group. It wasn't a message of condolence or any such thing. I had already heard from this student very shortly after Deanna left us. This time, the message was for another reason. He reached out to share a pivotal moment he'd had in patient care. And that's all.

The note was straightforward. He was taking care of a man with some cognitive issues and very limited literacy. An elder with not even a full elementary education and the kind of difficulty understanding things that was even harder back then because there weren't any names for such things or early interventions.

Yeah.

So anyways. Tony, from Small Group Alpha, is now a second year ENT resident. You can say "ear, nose, and throat" or, if you want to be all fancy with it, you can flex your linguistic muscles and say the proper name for it: "otolaryngology." Regardless of what you call it, that's what he's doing and I'm always elated to hear how it's going and how he's growing. And I'm glad that Tony still has a way and a desire to tell me about moments such as this.

This elder unfortunately had a recurrent throat cancer. Laryngeal cancer, to be exact. And Tony, being the head and neck surgeon (they go by that, too) was charged with coming in there to see this man and talk to him all about this procedure he was going to have. A procedure that would take away his ability to speak. For good.

And isn't it perfect that I'd receive this message at a time when people are thinking of things to be thankful for? We think of many things, but usually not our voice. At least I don't.

Well, Tony spent a lot of time talking to this gentleman and did so with care. No, I wasn't there, but I was there from the first day Tony started medical school. I listened to him and talked to him over the years so I know that it was important to him that this man understand what this surgery would entail. No matter how long it took, without question, I can say that Tony wanted to do all he could to afford this patient the chance to make the most informed decision possible.

And so. He talked. He explained. Carefully. And fully caring, too.

The gentleman had a tracheostomy tube in his throat at the time which limited his ability to speak during that conversation. But not yet permanently because there are speaking valves and such than can be used to help people talk. That is, if they have a larynx.

So after this young doctor spent all of that time speaking to him, he bit the bullet and did the thing that we are all taught to do but often come up with excuses to avoid. Ask the patient to tell back--or teach back--exactly what the gist of the plan is based upon their understanding.

This can be loaded. Mostly because if the person gets it all wrong, you're back at square one. Which, in my opinion, you're at whether you confirm it or not when the patient doesn't understand. A lot of times we feel the pressure of a ticking clock looming over us. The cop out question gets asked: "Any questions?" Which, most of the time, is often met with a "not right now."

That, or just one or two tiny ones that often gives the doctor the "dat'll do" wrap-up they were looking for. Especially if they are generic enough questions to convince us that we've explained things well.

But Tony did something even more extraordinary. He asked this question -- "What is your understanding of this surgery that I just talked to you about?" -- to a patient with a less than sixth grade education and some learning disabilities who also could not respond verbally. Having him write would be very tedious -- and time consuming -- but there wasn't another option.

Still, though, he asked. He respected that man enough to ask. Even more, he respected him enough to talk to him with the dignity he deserved and then positioned himself to have to wipe down the chalkboard and start all over again. He sure did.

And so. As his doctor patiently waited, the man took a piece of paper and scrawled these words in response to that question:

And I will tell you exactly what Tony said to me about this:

"Not sure exactly why yet, but I know this is one of the most important images that I'll see during my training."

I think he's right.

That entire note moved me in the deepest parts of my soul. I needed to hear that yesterday. Some other person's reality. If only for a moment, you know? Does that even make sense? I don't know.

Though I didn't cry, I did immediately feel like I wanted to when I saw this. And I'm not sure if it had to do with the fact that this man was losing his voice for good or the fact that this young doctor caring for him took the time to give him one.

Perhaps it's a bit of both.

Our voice is a gift. No matter what is going on, it is. And though I thought I knew that, this story underscored that for me even more.

I have this label I often use that you've seen and perhaps wondered about -- "yet do I marvel." (I know Nancy doesn't because she's all about the poetry, but others may wonder.) It comes from a poem from the Harlem Renaissance by a poet named Countee Cullen called "Yet Do I Marvel." There's lots of interpretations of the poem, so I won't go into all of that. What I will say is that I think the poem is hopeful and celebratory and not a lamentation. Against all odds, particularly the ones a man of color such as this author faced in the 1920's, he still had a voice. A voice!

So sometimes I see things and I just think to myself, "Wow." Because I'm just glad to be here. In spite of all that is going on in the world, I'm glad that I'm here to bear witness. I'm glad for hearts worn directly on sleeves. And especially in the time that I am walking through right now, I am glad for a voice.

A voice.

So to the dear person who couldn't believe that I could still write and talk through such unspeakable grief, I will share with you the poem my mother read to me as an elementary school kid -- likely close to the very age that patient was when he finished his education for good. Even though life doesn't make sense sometimes, there is always something in which to marvel.

Thank you, again, for thinking about me. There is much beauty in this post. Tony's interaction with this man was filled with irony, and I'm glad he was able to see the power in it.

Ah, Yet I Marvel. I know most people probably consider the punch of this poem to be the last line, but for me it's always been the first. The implication that [God... I know He means well], it just does it for me.

Is the African Violet a special flower for you? My in laws owned and operated Tinari Greenhouses since the 30's that grew and shipped only African violets. My FIL hybridized over a100 varieties...one even called the Mary Alice violet! I wishe he was still with us,cuz I would ask him to name one after Deanna.

What a beautiful post that for me was "fully loaded" as a woman who has struggled to find my voice in a marriage that ended in a divorce, in a profession that is male dominated, this patient's experience takes the concept of "voice" to an entirely different level. I am curious if you read Anne Lamott? I think of her when I read you and of you when I read her. Your family remains in my daily prayers.

i know when people say things like that, like how amazing that you could write at a time like this, they don't really get that it is the impulse to write at a time like this that gets us through. I am glad you have your voice and that you come to this place and share it with us. I am glad you were able to show us the love and the family laughs and the heartache and the gratitude all mixed up in missing your sister and understanding the blessing of having had her for the time you did. I am humbled and blessed and privileged to bear witness. My love. And thank you.

Wow...another hankie-worthy post, to be sure. Tony was onto something when he commented about that note's importance, and as someone who's known their share of physicians over the course of my life, some of them never quite reach that level of understanding. This post tells me you both have.

Had a curious thought about my own experiences, too, as I have one paralyzed vocal cord that gives me a unique and often queried voice; I hated it passionately as a kid, but things like this post give it an entirely different perspective. As quirky as it is, I'd be thoroughly lost without my voice. That patient's note would have killed me if I was his doctor. And...what Anonymous/Tara said.

Welcome to Atlanta.

"Becoming is better than being." - Carol Dweck

Who me? I'm just glad to be here.

Honestly? I write this blog to share the human aspects of medicine + teaching + work/life balance with others and myself -- and to honor the public hospital and her patients--but never at the expense of patient privacy or dignity.
Thanks for stopping by! :)

What's the point?

"One writes out of one thing only--one's own experience. Everything depends of how relentlessly one forces from this experience the last drop, sweet or bitter, it can possibly give."

~ James Baldwin (1924 - 1987)

"Do it for the story." ~ Antoinette Nguyen, MD, MPH

Details, names, time frames, etc. are always changed to protect anonymity. This may or may not be an amalgamation of true,quasi-true, or completely fictional events. But the lessons? They are always real and never, ever fictional. Got that?